5 tips to keep your exams on track

January 12, 2017

Article

Have you ever sat in the exam room with a patient and felt like the exam had gotten away from you?

The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

Have you ever sat in the exam room with a patient and felt like the exam had gotten away from you?

For example, let’s say the patient took over the exam with stories, anecdotes, and blind alleys.

Before you know it, 45 minutes have passed, and there’s a lobby full of angst-filled staff and patients waiting on you-the doctor, who is running behind again.

These things happen-they always will.

Part of being an amazing, respected doctor is that we must listen, care for, and take time with our patients.

Previously from Dr. Denton: 6 steps to open a practice

Sometimes you’re going to be ahead, and sometimes you will be behind. This doesn’t mean a plan can’t be formulated to help keep you on track while performing an exam.

We all have an exam flow-I think of mine as an essay from English 101.

Blame it on years of schooling and a liberal arts background, but I think that every story needs an introduction, body, and conclusion.

My exam structure helps me keep things going. When I think the exam has spun out of control, I can revert back to my natural flow to keep it moving.

Exam introduction (1 to 2 minutes)

I’ve read 100 times in 100 different places of statistics about how doctors never let their patients talk.

This is why I reserve a distinctive spot in my mind for the doctor-to-patient introduction.

“Hi, I’m Dr. Denton.”

Then I wash my hands, sit down, awaken the sleeping computer (because you know-the Health Insurance Portability and Accountability Act [HIPPA]), and give the patient a chance to talk.

No interruptions. I just listen.

I will have time later in the exam to get more specific information. I prefer to set the tone with patients that their exams are about them, and I’m here to listen.

Know what people like to talk about? Themselves!

Know what makes them feel warm and fuzzy? Being heard.

So listen-really.

Exam body (15 to 20 minutes)

This is the part of the exam where I get busy: conducting tests, asking directed questions, and doing my doctor thing.

Remember the 30 to 60 seconds you give patients to be heard in the introduction? This is your chance to get the important information out of them.

This part of the exam doesn’t need much advice because most ODs are on autopilot during this portion.

Exam conclusion (3 to 5 minutes)

I think it’s important to wrap everything up with a neat, little bow at the end of every exam. I prefer this rather than saying, “Well, everything looks great, see you next year!”

My exam conclusion is always the same.

I communicate to patients that my responsibilities to them are two-fold:

• Make sure they see clearly and comfortably

• Ensure their eyes are not only healthy today, but set up to be that way their entire lives

Know what I get when I tell patients this? Lots of head nodding.

Notice that as you go into further detail on each point, your patients are following along with you. Patients enjoy that I have key responsibilities to them as their doctor that I take very seriously.

Clarifying the exam

Giving patients a chance to ask questions at the end is essential.

The two moments of listening during an exam are at the beginning and at the end. These moments are instrumental in making our patients feel cared for.

What do I usually hear when I ask?

“No doc, you explained everything better than I’ve ever heard before.”

Music to my ears.

The follow-up

No exam is complete without making a date to see the patient again.

Leaving the follow-up exam open ended sends a clear message to patients that they can come in whenever they feel like it.

Let patients know when they need to come see you again. Get their follow-up appointment scheduled or pre-appointed-even if it's a year out.

Related: Be present with your patients

Examine other ODs’ processes

There are many ways to help improve your exam process. It doesn’t just stop at these five steps.

Sitting in and listening to other ODs at conferences has also helped me craft my exam flow.

No matter what, constant growth and self-reflection on the way we serve our patients is what allows us to grow as doctors.

How do you make your exam flow?